Centers of Excellence

The Lung Center

What are empyema and lung infection?

Empyema is an accumulation of pus in the pleural space, the cavity between the lungs and the inner surface of the chest wall. Infection within the lung (pneumonia) can be coughed out. Infection in the pleural space (empyema) cannot be coughed out and must be drained by a needle or surgery. Sometimes called pyothorax or purulent pleuritis, empyema develops when bacteria invades the pleural space. A pleural effusion or “water on the lung” can develop into an empyema, a more serious and life-threatening condition. Empyema is typically caused by an infection such as pneumonia or following surgery.

Chronic infections of the lungs from pneumonia, tuberculosis, non-tuberculous mycobacterial (NTM) infections and influenza as well as fungal and bacterial infections can also be extremely serious, leading to millions of deaths worldwide annually.

The Lung Center at Brigham and Women’s Hospital (BWH) provides specialized evaluations and innovative treatment for people suffering from empyema and lung infections. Our board-certified surgeons perform minimally invasive surgical techniques such as thoracoscopic drainage with decortication using video assisted thoracic surgery (VATS), to remove infected tissue and relieve symptoms with minimal discomfort.

What are the risk factors for empyema and lung infection?

Factors that put a person at risk for developing infections of the pleura (empyema) or infections of the lung include:

  • Pneumonia
  • Lung abscess
  • Recent surgery or trauma to the chest
  • Chronic lung disease
  • Elderly
  • Weakened immune system
  • Viral disease
  • Swallowing difficulty

Empyema starts as thin infected tissue that prevents the lung from working. After a few days, this fluid becomes thick (gelatinous), and must be scraped out. If left inside, the gelatinous material turns to a scar on the lung like the peel of an orange. The last stage, pneumothorax, can cause permanent disability.

What are the symptoms of empyema and lung infection?

Signs and symptoms of empyema and lung infections include:

  • Chest pain
  • Dry cough
  • Excessive sweating
  • Fever and chills
  • Shortness of breath
  • Sharp or stabbing chest pain
  • Headache
  • Confusion
  • Loss of appetite, low energy, fatigue
  • Weight loss

How is empyema and lung infection diagnosed?

Your BWH thoracic surgeon may conduct the following diagnostic tests and procedures after noticing an abnormal sound when listening to your chest with a stethoscope:

  • Chest CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat, and organs.
  • Chest X-ray uses invisible radiation energy beams to produce images of internal tissues, bones, and organs on film or digital media.
  • Thoracentesis, where a needle is inserted through the back of the ribcage into the pleural space to remove fluid or air.
  • Pleural fluid analysis examines the fluid under a microscope to look for bacteria, protein and cancer cells.
  • Ultrasound uses sound waves to tell where the fluid is located.

What is the treatment for empyema and lung infection?

The goal of treatment is to cure the infection by removing pus and affected tissue, draining the pleura or lung and reduce symptoms. Treatment methods include:

  • Medication
    • Antibiotics
  • Minimally Invasive Surgery
    • Percutaneous thoracentesis can be used if the empyema is very early with just thin fluid. A needle is inserted into the pleural space to drain fluid.
    • Thoracostomy: After providing your sedation and injecting a local anesthetic into your ribcage where the fluid is located, your physician will insert a plastic tube into your chest between two ribs, connect the tube to a suction device and remove the fluid. Special medicines can be injected to help the fluid drain.
    • Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into three small incisions without any spreading of the ribs. This operation is performed under anesthesia in the operating room. The surgeon is able to remove restricting tissue around the lung, insert a drainage tube or apply medicine to reduce fluid accumulation.
    • Open decortication, if required, is a surgical procedure to peel away the scar peel that formed on the lung so it can re-expand. This can prevent permanent disability.

What can you expect for empyema and lung infection care?

When you become a patient of The Lung Center, you will receive a thorough diagnostic examination and receive clinically-proven treatment by a board-certified thoracic surgeon who specializes in infections of the pleura (empyema) and lung. Our goal is to alleviate or eliminate symptoms and prevent loss of lung function so patients can confidently resume everyday activities.

You will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with thoracic problems. After surgery you will go to the recovery room (Post Anesthesia Care Unit) and then you will be transferred to the Thoracic Intermediate Care Unit (TICU) where you will receive specialized comprehensive care by an experienced medical and nursing staff to get you better rapidly.

Who provides empyema and lung infection care?

Empyema and lung infections patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, oncologists, pulmonologists, cardiovascular medicine physicians and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any surgery recommended will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with disorders of the lung.

How do I book an appointment or find directions?

What other resources exist on empyema and lung infection care?

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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